Healing from violent relationships through long-term support

On alternating Thursdays for two years she took two buses to get to the women’s shelter in Brownsville, Texas, for her peer support group. Twice a month, she sat in a circle with 10 or more women and listened as they shared about their experiences escaping violent intimate relationships. The women, now her closest friends and confidants, would each take their turn, one by one around the circle until it came to her. “Pass,” she would always say. Her words could only pound deep in her throat before welling up in her eyes and spilling down her cheeks as tears.

For two years, she silently sat and listened to her friends’ stories of fear, courage, survival and strength. They had fled their violent homes and were tediously building new lives for themselves and their children. Their words piled inside her like bricks, until eventually, she could use the bricks to climb out of herself and speak. When her voice finally stretched into the room, it landed on the only ears that could understand. Her story was theirs.

The group

When Nora Montalvo-Liendo, RN, PhD, FAAN, invited women who had survived intimate partner violence to come together and talk, she had no idea many would still be coming 10 years later. Montalvo-Liendo, who is an assistant professor with the Texas A&M College of Nursing, says she decided to start a peer support group after working with the women’s shelter for a study she conducted in 2008.

“I wondered what happened with the women after they left the shelter,” she said. “I asked the director and she said they do have support groups, but they’re only 10 to 12 weeks long and are limited in size since they are structured therapeutic groups.”

Montalvo-Liendo felt strongly that the women needed a long-term group where they could have time to build trust with someone who would listen and understand the challenges they were facing after the abuse. To create the space she envisioned for them, she started bi-weekly support groups at the women’s shelter in April 2009, and in April 2018, slightly modified them to once a month.

The challenges

“Some of the challenges and stressors that we experience in our daily lives cannot even begin to be compared to what these women are facing,” Montalvo-Liendo said. “They’ve just gone through six, 20 or even 30 years of an abusive relationship, and now they’re homeless and living at the women’s shelter. These women with children are starting all over again financially, socially and emotionally. This group gives them the opportunity to come together, talk about what’s going on in their lives and help each other.”

In the Rio Grande Valley region of Texas where Montalvo-Liendo works, many of the women who come to her group are Mexican immigrants. Some were even brought into the United States illegally through human trafficking. She says for these women, building their lives back up post abuse is especially difficult because safety and security is not a threat only at home. They are also vulnerable to the fears of stepping outside their home and being separated from their children by Border Patrol Agents, just by simply walking to their children’s school or riding the bus to find domestic work. Because many of these women don’t have permits to work in the United States legally, Montalvo-Liendo encourages them go through the long and complex process of obtaining immigrant employment paperwork so they can stay in the country and support their children.

“Until they get their paperwork, they have to find whatever domestic work they can,” Montalvo-Liendo said. “So, they have those challenges, and then they constantly worry about helping their children. Because the children have also been exposed to severe violence in the home, they start to have problems in school, struggle with depression, decline academically and have behavioral problems. It helps for the women to talk with other mothers who are also struggling to do the best they can to raise healthy children. When they share, they know they’re not alone.”

With no agenda, curriculum or restrictions on size, the support group Montalvo-Liendo leads is simply an opportunity for the women to come together for one hour per month, talk about their struggles and triumphs, and share inspiration, resources and suggestions for healing and growing post abuse. Many of the women come from the women’s shelter, but others find the group through the local non-profit agency for outreach services.

“Some of the women who have been coming to the group for a while have gone on to get their work permits and now have a job. Occasionally, they’ll take a day off work to come back and tell the group how they’re doing,” Montalvo-Liendo said. “They tell them they’re doing fine, they’re working now and their kids are fine.”

The study

After 10 years of leading the group and witnessing positive outcomes, Montalvo-Liendo wanted to find out if the long-term support group was having an actual impact on the women. She enlisted the help of colleagues to evaluate the group, and they’re currently drafting manuscripts to be published.

Montalvo-Liendo, along with Robin Page, PhD, APRN, CNM, assistant professor at the Texas A&M College of Nursing, Jenifer Chilton, PhD, RN, assistant professor at the University of Texas at Tyler School of Nursing, and Angeles Nava, PhD, RN, at Texas Woman’s University College of Nursing, interviewed 49 women who have been through the long-term support group. They then conducted a qualitative review of the interview transcripts and identified a number of common themes.

“The findings are overall positive,” Page said. “In general, the women said they felt the groups were very helpful for them, and we feel like it was primarily due to several reasons.”

The first trait of the group the researchers identified as being beneficial is that it is long-term and has been facilitated by the same person from the beginning. This allows for a trusting relationship within the group, which is especially important for women who have been battered or violated as the women in the study have. The other unique trait of the group is that it is nurse-led. For Page, this is important.

“I feel like nursing really brings in a whole-person perspective, which includes the mind, body and spirit,” Page said. “Mental health often drives physical health, and physical health is something nurses are in a unique position to address. These are women who are coming from relationships where they were abused, so if there is a physical issue, nurses can recognize it and get the women to the appropriate care.”

The findings

After analyzing transcripts from the interviews, the research team identified three ideas, or themes, the women repeatedly brought up: awakening, community and empowerment. In the awakening category, the women said things such as, “Now my eyes are open” and “I thought it was my fault.” In these instances, the women revealed that after talking with their peers in the group, they were able to realize that abuse is not okay and they do not have to suffer through an abusive relationship.

Women who felt a sense of community said, “I became we,” “I am not alone,” and “We share everything.” One woman said, “My problems are small compared to others.”

“Sometimes, when we are struggling, we tend to become very insular,” Page said. “For this woman, going to the long-term support group made her realize there are others with problems even bigger than hers. For her, that was kind of comforting.”

Another idea that came up frequently the research team termed empowerment. “One of the women said, ‘I came out feeling stronger.’ To me, that said this really empowered her to feel stronger about herself and her ability to cope with this life situation,” Page said.

The woman

Part of the long-term support group that Montalvo-Liendo provides is an empowerment fund she started with stipends from her presentations. The women from the group are able to apply for funding to help support their children’s extracurricular activities, which is difficult for many of them to afford as sole providers of their households struggling to keep the lights on and food in the refrigerator.

For two years, one woman came to the support group for every session but never spoke. This woman had been through horrible adverse childhood events and lived with intimate partner violence for years. During the group sessions, she could only manage to cry, listen and absorb until she built up enough strength to speak.

Today, Montalvo-Liendo says this woman speaks often and openly, and sometimes even opts to pass on sharing because her updates for the group are so positive. She now has her work permit and a steady job, and has been able to keep her children involved in extracurricular activities. The empowerment fund allowed this woman to take her daughter to a dance competition in Houston. The fund paid for her daughter’s outfit and shoes as well as travel expenses for the woman, her daughter and son.

“I have witnessed her grow so much since she first joined the group,” Montalvo-Liendo said. “She’s dealt with a lot of terrible events in her life, but because she attended this long-term support group, she became strong enough to handle all those crises that came her way, even the aftereffects.”